title: Measuring quality in diabetes care: an expert-based statistical approach.
abstract: We present a methodology for using health insurance claims data to monitor quality of care. The method uses a statistical model trained on the quality ratings of a medical expert. In a pilot study, the expert rated the quality of care received over the course of two years by 101 diabetes patients. A logistic regression model accurately identified the quality of care for 86% of the patients. Because the model uses data derived from patients' health insurance claims it can be used to monitor the care being received by a large patient population. One important use of the model is to identify potential candidates for case management, especially patients with complicated medical histories.
authors.affiliation: MIT Medical, Building E23, 77 Massachusetts Avenue, Cambridge, MA 02139-4307 USA.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Bertsimas
authors.forename: David
authors.initials: D
authors.lastname: Czerwinski
authors.forename: Michael
authors.initials: M
authors.lastname: Kane
keywords: Claims data; Diabetes; Logistic regression; Quality of care